Spring 2010 LACROSSE Registration Form
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! Indicates required information
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| RYSI USE ONLY: |
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SPORT
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| ! Did you play RYSI Football or Cheer in 2009?: |
No
Yes
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| How many years have you played lacrosse?: |
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| ! Position played?: |
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| What is your US Lacrosse number?: |
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If you do not have a US Lacrosse #, please go to USLacrosse
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Spring 2010 Program cost is $155.00 (includes uniform)
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PLAYER INFORMATION
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| ! Age as of April 1, 2010?: |
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| ! Grade as of September 2009: |
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| ! Player First Name: |
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| ! Player Last Name: |
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| ! Date of Birth: |
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| ! HOME Phone - Primary (xxx-xxx-xxxx): |
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| ! Address: |
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| ! Town: |
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| ! State: |
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| ! Zip Code: |
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| ! School as of September 2009: |
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| If 'Other' School - Please provide school: |
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PARENT / GUARDIAN INFORMATION
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| ! #1 Parent/Guardian - First Name: |
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| ! #1 Parent/Guardian - Last Name: |
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| Address: |
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| If 'Other' - please provide Town, State & Zip: |
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| Cell Phone (xxx-xxx-xxxx): |
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| Work Phone (xxx-xxx-xxxx): |
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| ! Email Address (All Information during season): |
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| ! Re-Enter Email (All Information during season): |
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| #2 Parent/Guardian - First Name: |
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| #2 Parent/Guardian - Last Name: |
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| Address: |
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| If 'Other' - please provide Town, State & Zip: |
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| Cell Phone (xxx-xxx-xxxx): |
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| Work Phone (xxx-xxx-xxxx): |
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| Email: |
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MEDICAL/EMERGENCY CONTACT INFORMATION
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Please list someone OTHER than yourself.
We will try parent(s) first.
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| ! Name: |
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| ! Phone (xxx-xxx-xxxx): |
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| ! Relation to Player: |
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| ! Health Insurance Provider: |
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| ! Health Insurance Reference Number: |
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VOLUNTEER OPPORTUNITIES
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If you are interested in COACHING, please note COACHING CLINIC Saturday, November 21, 2009 (10AM - 1PM) Fairleigh Dickinson University. Provide Name and contact email below if interested. You will be contacted with further information.
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If you are interested in being TEAM MANAGER, please provide name and contact email below if interested.
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| Interested in Coaching, Team Manger or Both?: |
Coaching
Team Manager
Both
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| Name (Last, First) -: |
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| Contact Email -: |
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MEDIA FORM (ACCEPT / DECLINE) PERMISSION
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Please ACCEPT or DECLINE your permission for photos and/or video depicting your child's image to be used on the organization's website (www.ridgeyouthsports.com).
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| ! PERMISSION: |
Accept
Decline
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CONSENT AND RELEASE CLAUSE
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As the parent or legal guardian of the child named above, I hereby certify that, in consideration of the benefits to our child/ward, and other children to be gained through their participation in the athletic activities sponsored by North Jersey Lacrosse League, I give my full consent and approval for my child to participate as a team member of the sport designated above.
I understand that there are certain risks of injury in the practice and play of this sport, as well as in traveling and other related activities incidental to my child's participation, and I am willing to assume these risks on behalf of my child. I hereby certify that my child is healthy and has no physical or mental disabilities or infirmities that would restrict participation in these activities.
In addition to giving my full consent for my child's participation, I do hereby waive, release and hold harmless the following: Ridge Youth Sports, Inc, North Jersey Lacrosse League, Bernards Township and all of their trustee’s officers, employees, and coaches, sponsors, supervisors, volunteers and representatives from any and all claims arising out of such injury that may be suffered by my child or myself as a participant or spectator in the normal course of participation in the designated sport and the activities incidental thereto, whether the result of negligence or any other cause. Any equipment issued to my son/daughter will be returned as directed by the team coaches or officials and I agree that I am liable for the replacement of any lost equipment issued to my son or daughter.
I have read and understand all points contained in the Parental Code of Conduct and Player Code of Conduct
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| ! Name of Parent or Guardian for Approval of Consent and Release Clause (First & Last Name): |
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| ! Date of Consent Approval (today's date): |
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You will receive an email in early 2010 regarding
Physician Form and Power of Attorney for 2010.
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Please see CONTACTS (from Main Menu) should you have questions or concerns with OnLine Payment.
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! Indicates required information
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Select the appropriate fee for this registrant:
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Note: Credit Card information can be entered once this form is complete.
We accept the following credit cards
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